Even though amenorrhoea or failure to menstruate is mostly associated with young dancers, gymnasts and runners whose
activities demand lots of strenuous exercise and a lithe body, exercise typically has a beneficial influence on most the menstrual problems.
Amenorrhoea
Amenorrhoea or failure to menstruate is a normal condition in girls who have not yet reached puberty. However, if menstruation has not started by the age of sixteen the condition is regarded as abnormal and a doctor should be consulted. Primary amenorrhoea, as this condition is called, can mostly be traced back to hormonal imbalances and malnutrition or, less commonly, genetic or structural abnormalities (such as the absence of a uterus) and is not caused or influenced by sport or exercise.
Secondary amenorrhoea, also one of the hallmarks of anorexia nervosa; a serious eating disorder characterised by excessive dieting and weight loss, may be influenced or caused by over-exercising, stress, obesity, hormonal disorders, tumours and the use of oral contraceptives and other medication. Chronic diseases such as thyroid malfunctions, diabetes and some types of cancer may also cause secondary amenorrhoea.
Sport and exercise may, in some instances be taken too far! For example, young gymnasts, ballet dancers, swimmers and athletes who train very hard and exercise and run to help control their weight sometimes lose perspective concerning proper body weight and size and percentage of body fat necessary to function and menstruate properly.
Although demanding sporting activities and exercise are often blamed for lack of menstruation in adolescent girls researchers have put together an interesting profile of the “typical” young sports star that may be susceptible to menstrual irregularities and amenorrhoea. They describe her as a young female who most probably started menstruating quite late anyway (and who may have experienced menstrual problems prior to starting an exercise regime. She is also likely to be a vegetarian with a slight build and low body weight to start with, and a possible history of eating disorders who trains heavily and is a better than average performer.
When these girls’ periods become very light or non-existent it means that that little or no oestrogen; the female sex hormone, is circulating in their blood. Oestrogen is essential for the regulation of menstruation and fertility as well as the replacement of bone minerals. Hormonal imbalances and lack of bone minerals may eventually lead to decreases in bone density and a pronounced susceptibility to osteoporosis in later life.
Girls with athletic amenorrhoea need to be treated with oestrogen and progesterone supplements to prevent infertility and difficulties in conception as well as calcium to help strengthen their bones. However, the other extreme of no exercise and obesity may also hinder reproductive health.
Low body fat: the other culprit
Intense training does not always cause menstrual dysfunction as low body fat may also play a role. Traditionally height/weight charts gave an accurate portrayal of overweight, yet, experts now believe that body mass index (BMI) may supply a more accurate picture of health. Calculate your daughter’s BMI by dividing her weight (in kilograms) by her height (in metres, squared). According to the experts, women and girls should keep their BMI above 17.5; the minimum level to initiate menstruation.
Watch what they eat
Young sports stars need to be reminded that trying to lose weight by eating less and exercising more will have an adverse effect on their health in the long run. Nutritional therapy is the preferred complementary treatment for amenorrhoea related to excessive dieting and thinness as well as obesity. Parents of girls suffering from secondary amenorrhoea should consult a dietician or sports dietician to help their daughters plan a diet that provides the proper nutrition for peak athletic performance without jeopardising normal menstruation patterns. This may involve increasing food intake early in the day (a good hearty breakfast followed by a light lunch and afternoon snack) to fuel training schedules. Dinner should be the lightest meal of the day.
However, hospitalisation may be required in serious cases of amenorrhoea associated with anorexia nervosa, in order to treat the malnutrition and other complications of starvation. Eating disorders also require both psychological and medical care.
The parent’s role
Parents whose daughters fit the description of the typical intensely competitive, slightly-built, late-bloomer, described above should try to counteract obsessive training by encouraging their young daughters to exercise diligently but moderately, to eat a balanced diet and to live a balanced life. Parents and coaches who place too much emphasis on performance and winning will only exacerbate the already existing problem.